Brain Injury Awareness Part 1: It all starts with prevention

EDitor's Note: This article has a graphic photo below, which some readers may find unsettling.

While rock-climbing with a friend in the mountains along the coast of Washington state Oct. 5, 2014, Coast Guard Petty Officer 3rd Class Colin Woodside did something out of the ordinary: He left his helmet behind.

“I always wear one,” said the San Diego-based maritime enforcement specialist, “but I forgot some gear on the top of the climb. And since it was just a short scramble back up to get the gear and a hike back down, just this one time, I didn’t [wear a helmet].”

He had climbed many times in this area and felt comfortable going back the short distance for his forgotten equipment without either a helmet or a rope.

Woodside lost his footing on the rocky ledge and fell more than 50 feet. He landed headfirst and bashed a three-centimeter crater into the side of his skull. While he stayed conscious and mobile after the accident, the injury was so severe Woodside admitted he doesn’t remember what happened that day or the next two weeks afterward. MHS medical staff helped Woodside battle back from his injuries to return to full active duty. But it was a traumatic brain injury that could have been avoided.

“Prevention is multifaceted,” said Scott Livingston, Ph.D., the Defense and Veterans Brain Injury Center education division director. “Primary prevention of TBI aims to reduce the risk of injury happening in the first place. Once someone has sustained a TBI, our aim then is preventing any secondary complications and subsequent injuries.”

TBIs are among the most devastating injuries faced by service members. The severity of TBIs range from mild – also known as a concussion – to moderate, severe, and penetrating injuries, and can result in both short-term and long-term effects. According to DVBIC, nearly 360,000 troops have sustained some type of TBI since 2000, with 80 percent of these injuries occurring in noncombat settings. Many happen during training, as a result of vehicular or motorcycle accidents, or accidents that happen during recreational activities outside of work—like rock climbing.

Livingston compared prevention efforts to what occurs in organized football. Players are fitted with the correct helmet and taught the proper way to wear it. Helmets won’t prevent all concussions, so coaches or medical staffs must remove a player from the game to prevent what can be an even more devastating second injury.

“Once someone sustains a TBI,” said Livingston, “you want to give the brain a chance to heal and fully recover before allowing them back to sports. If a person goes back to play too soon [while still experiencing symptoms], they are three to six times more likely to suffer a subsequent brain injury.” He said additional concussions can have a snowball effect of worsening symptoms and extended recovery.

Doctors used staples to close the wound on Woodside after a 50-foot fall while rock climbing resulted in a traumatic brain injury.

Recent advancements in military helmet design protect warfighters better. Livingston said while these improvements in helmet technology help reduce the risk of serious head trauma, there is still a risk of TBIs, especially from the pressure waves caused by a blast. Helmets are not concussion proof. That’s why commanders and leaders in the field need to know that even if the head doesn’t take a direct strike from an object, that troop still needs to be checked out by medical staff.

“People need to recognize when they or one of their service members are in a situation that could have caused a concussion, ” said Livingston, “such as being within 50 meters of a blast or being involved in a rollover collision, even if there’s no visible signs of head trauma.” It’s vital that leaders remove injured service members from a training or combat environment to prevent injuries from a subsequent TBI, he said.

Livingston encouraged everyone to wear proper safety equipment since most TBIs happen away from deployment and combat. Wear military helmets in training settings, bicycle or motorcycle helmets when riding, and specialty helmets for other recreational activities such as snowboarding and rock climbing. And always wear a safety belt when riding in or operating a motor vehicle.

For Woodside, suffering a TBI put everything in perspective, especially not taking his own safety for granted.

“It was the day that changed the rest of my life,” said Woodside. “When I got hurt because of my own actions, it really gave me a humble check.”

The Office of Naval Research is sponsoring the development of a portable, three-part system that can measure blast pressure, establish injury thresholds for the brain and analyze potential TBI symptoms

Air Force School of Aerospace Medicine scientists are testing and evaluating a novel aeromedical evacuation stretcher designed to safely transport traumatic brain and spinal injury patients in air and ground vehicles